Bernie Sanders and Jake Tapper argue about Medicare-for-all

John SextonPosted at 5:21 pm on August 20, 2018

Is Medicare-for-all a bargain or is it an unsustainable fiasco? Well, it depends on who you ask. Today, Bernie Sanders attacked criticism of his Medicare-for-all proposal which arose in a report by the Mercatus Center. In case you missed it, you can read Ed’s post on the topic from last month.

The Mercatus white paper looked at the Sanders’ plan and concluded that if everything operated as he intended there would be a $2 trillion savings over 10 years. Sanders and Alexandria Ocasio-Cortez have seized on that finding to claim that even the Koch brothers (who fund the Mercatus Center) agree Medicare-for-all will save America a lot of money.

But the author of the report says they are missing his point. Charles Blahous, a former economic adviser to George W. Bush, says those figures require significant cuts to doctor payment rates that aren’t likely to ever happen. If you score the same plan without those deep cuts, Medicare-for-all would wind up costing several trillion dollars per year rather than saving money.

CNN’s Jake Tapper, in partnership with FactCheck.org, ran a fact-check about this issue last week:

And earlier today, Bernie Sanders seized on an apparent edit to the CNN fact-check to claim that critics of his claims about Medicare-for-all and the Mercatus paper are wrong:

1) We correctly state that the Mercatus report found that the American people would save $2 trillion over 10 years under Medicare for All. That finding is right here in Table 2 of the Mercatus study. pic.twitter.com/E56u6pDUrw

3) What Tapper and others have done is say we're wrong because Blahous didn't actually intend to find that Medicare for All would be a great deal for Americans. The problem is: Blahous did find it would save $2 trillion – he just doesn't like that people are celebrating it.

5) @swoolhandler and @awgaffney have found that even though the Mercatus study “grossly underestimates the main sources of savings” from Medicare for All, the “central finding” from the study is that it saves Americans $2 trillion over a decade. https://t.co/6MwP7TrmIP

7) Harold Pollack at the University of Chicago said: "Over the long run, the Sanders people are very correct that you could implement a system like this that would be more disciplined, more economical and more fair than the current U.S. health system." https://t.co/VJukz9EmUp

There’s a bit more of this but you get the gist. Jake Tapper responded by pointing out that several independent fact-checkers had concluded pretty much the same thing, i.e. Sanders is leaving out most of the context when claiming the Kock brothers’ paper had proven his plan would save money:

While Sanders takes this opportunity to hammer the Mercatus study, a reminder that we never took a position on the study, or on Medicare-for-all. We stated — as has every major fact checker — that he didn’t provide the full context of the study when saying it backs his argument. https://t.co/ZPkdxob3g0

Tapper concludes by noting that none of these fact-checkers were funded by the Koch brothers:

6/ Not one of the fact checkers supported the Mercatus Center study nor did any of us oppose the Sanders plan Medicare-for-all. But we all maintain he’s using the study in a way that doesn’t provide the full context of the study.

So who is right? Well, Sanders is correct about what the Mercatus report says if all the assumptions in his plan work out. But the whole point of the paper was to argue that, apart from drastic cuts to providers, those savings won’t materialize. At the Washington Post, Glenn Kessler notes that this wouldn’t be the first time planned provider cuts didn’t pan out:

Congress has passed cuts to health-care providers that do not come to fruition. Most famously, the 1997 balanced-budget agreement between President Bill Clinton and the GOP-led Congress included cuts that Congress deferred for 17 years with an annual provision known as the “doc fix.” It was finally eliminated under a deal Obama reached with Congress in 2015, or else providers would have faced a cut of 21 percent. Other efforts to control spending in Medicare, however, have fared better, including as part of the enactment of the Affordable Care Act.

In 2012, Blahous wrote a study questioning the budget assumptions in the ACA, such as the political prospects for a tax on “Cadillac” health plans. He turned out to be right: The tax keeps getting pushed off and weakened. Health-care costs did decline after the passage of the ACA, but whether that pre-dated the law or not is a subject of continuing debate.

So the point here is that if Sanders’ plan results in another annual “doc fix” then the cost of his Medicare-for-all plan will turn out to be tremendous. And that’s a completely fair point to make given the recent history of health care legislation.